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FEATURE
their medical practices. The concept of a spiral curriculum with
increased focus on the scientific basis of medical practice during
the clinical years and integration of teaching across organ systems
will provide many opportunities to illustrate clinical applications
of genomic medicine. Similarly, as students progress from basic
to complex patient presentations, there will be many opportunities
to incorporate concepts that are central to genomic medicine, such
as individual variation in disease susceptibility, response, and
treatment.
Unfortunately, however, the renewed curriculum could
turn out to be even less effective than the current curriculum in
teaching the fundamental principles and conceptual framework
of genomics. The same factors that have impaired the current
curriculum, namely poor integration of foundational science with
clinical medicine and variability in the learning experience among
students, 8 could hamstring the new curriculum. The renewed
curriculum will teach structural biology, physiology, biochemistry,
pharmacology, and pathology almost entirely in the context
of clinical presentations, and there will be little opportunity to
discuss transcendent basic science principles apart from their
relationship to the pathophysiology of particular diseases. This
change in the curriculum is concerning, especially for the study
of genomics where the underlying mechanisms, which need to
be understood to apply the principles to other situations, are
frequently not apparent at the level of the phenotype. Focusing
only on the applied end of genomic knowledge is likely to produce
rote learning of “factoids,” rather than a deep understanding of
the principles that provide a framework for appropriate use of
genomics in future clinical situations.
In addition, while the incorporation of “scholarship &
science/academics” 9 as an ongoing activity throughout clerkship
offers the possibility of improving students’ understanding of
the basic science that underlies particular clinical problems,
the presentation of this stream as a separate component of the
curriculum could make it largely irrelevant for most students. It
will be challenging to maintain the engagement of students in
“scholarship & science/academics” 9 when it competes with their
time for clinical learning at the bedside.
The best solution, of course, would be to eliminate the
distinction between clinical and science/academic learning by
assuring that all clinical teaching is based on and used to illustrate
contemporary scientific knowledge. This could easily account for
20% of learners’ time on the wards, in clinics, or in physician’s
offices, but it would be very difficult to implement, maintain, and
monitor in a widely distributed medical curriculum. It would pose
a particular challenge at UBC, where most clinical teaching is
performed by busy clinicians whose first concern is, and must be,
providing care to their patients. The problem is even greater with
respect to genomic medicine because most B.C. physicians have
limited knowledge of genomic technologies or how to incorporate
them into clinical practice. 1
A MADE-IN-BRITISH COLUMBIA SOLUTION
Preparing physicians to practice genomic medicine means
including learning materials in the curriculum that will enable
students to understand the principles of genomics and to achieve
the competencies needed to apply these principles clinically. The
renewed curriculum must contain a comprehensive set of specific
genetic and genomic competencies, not just a few adventitious
objectives that may fit into an occasional presentation focused on
other issues.
If genomic medicine is integrated throughout the curriculum,
as it should be, evaluation of these competencies will need to be
ongoing and cumulative throughout the entire medical school
experience. Students should be expected to demonstrate their
understanding of fundamental genetic and genomic principles
explicitly, as well as the clinical competencies that derive from
them.
British Columbia has very strong resources in genetics and
genomics. The Michael Smith Genome Sciences Centre is a world–
leading site for genomics and bioinformatics research. The B.C.
Provincial Medical Genetics Program is among the largest and
most comprehensive clinical genetics services in North America,
and the UBC Department of Medical Genetics includes one of
the most distinguished groups of human geneticists in Canada.
These faculty members could provide outstanding curricular
materials and learning support in genetics and genomics for the
undergraduate medical curriculum.
Integrating genomic learning throughout the renewed
curriculum will not be effective without initially providing
students with an opportunity to master the fundamental principles
of genetics and genomics. Clinical problems that focus on fostering
a deeper understanding of genetic and genomic principles could
be used in the early portion of the curriculum to provide students
with the conceptual framework needed to address specific clinical
applications later in their medical education. This might require
some flexibility in the presentation–based curriculum as currently
envisioned, but would be consistent with the concept of a spiral
curriculum. It would not be easy for clinical faculty throughout
the province to teach or guide students in learning material that
is unfamiliar to the faculty members themselves, but the renewed
curriculum will provide opportunities for many other kinds of
distributed learning for both students and faculty.
In 2009, Genome British Columbia presented a bold vision
of British Columbia as a “Personalized Medicine Province.” 10
The goal was to provide British Columbians with access to the
best healthcare in the world and optimize the use of available
economic resources. Personalized medicine was seen as the key
to more accurate individualized diagnoses, which would in turn
assure that the right patient receives the right treatment at the
right time. Making genomics a central organizing principle of the
UBC medical curriculum by spiraling from an understanding of
the conceptual framework through increasingly complex clinical
applications throughout the four years would be a giant step
toward making this vision a reality.
REFERENCES
1. Thomas M, Phillips L, Taylor J, Johnson Z, Birch P, Thomas R, Adam S, Hayden
MR, Friedman JM. Survey of BC physicians: exploring current knowledge and
impact of genomic technologies on clinical practice. Vancouver (BC): BC Clinical
Genomics Network (BCCGN); (Manuscript in preparation).
UBCMJ | FEBRUARY 2013 4(2) | www.ubcmj.com
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